Surgical device with articulation and wrist rotation

ABSTRACT

A surgical instrument comprising a handle assembly, an elongated shaft, an end effector, a rotation mechanism, and an articulation mechanism is disclosed. The rotation mechanism is disposed in mechanical cooperation with the handle assembly and effects rotation of the end effector about the second longitudinal axis. The articulation mechanism is disposed in mechanical cooperation with the handle assembly and effects movement of the end effector from a first position where the first longitudinal axis is substantially aligned with the second longitudinal axis to a second position where the second longitudinal axis is displaced from the first longitudinal axis. The articulation mechanism comprises a first articulation control disposed in mechanical cooperation with the handle assembly, a first cable and a second cable. Actuation of the first articulation control in a first direction causes the first cable to move distally and causes the second cable to move proximally.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. patent applicationSer. No. 13/543,931 filed on Jul. 9, 2012, which claims the benefit ofand priority to U.S. Provisional Patent Application No. 61/505,604,filed Jul. 8, 2011, the entire contents of which are incorporated byreference herein.

BACKGROUND

The present disclosure relates to a device for surgically manipulatingtissue. More particularly, the present disclosure relates to a devicefor surgically joining and/or cutting tissue utilizing an elongated,generally flexible and articulating shaft.

TECHNICAL FIELD

Various types of surgical instruments used to surgically join tissue areknown in the art, and are commonly used, for example, for closure oftissue or organs in transection, resection, anastomoses, for occlusionof organs in thoracic and abdominal procedures, and forelectrosurgically fusing or sealing tissue.

One example of such a surgical instrument is a surgical staplinginstrument, which may include an anvil assembly, a cartridge assemblyfor supporting an array of surgical staples, an approximation mechanismfor approximating the cartridge and anvil assemblies, and a firingmechanism for ejecting the surgical staples from the cartridge assembly.

Using a surgical stapling instrument, it is common for a surgeon toapproximate the anvil and cartridge members. Next, the surgeon can firethe instrument to emplace staples in tissue. Additionally, the surgeonmay use the same instrument or a separate instrument to cut the tissueadjacent or between the row(s) of staples.

Another example of a surgical instrument used to surgically join tissueis an electrosurgical forceps, which utilize both mechanical clampingaction and electrical energy to effect hemostasis by heating the tissueand blood vessels to coagulate, cauterize and/or seal tissue. As analternative to open forceps for use with open surgical procedures, manymodern surgeons use endoscopes and endoscopic instruments for remotelyaccessing organs through smaller, puncture-like incisions. As a directresult thereof, patients tend to benefit from less scarring and reducedhealing time.

SUMMARY

The present disclosure relates to a surgical instrument comprising ahandle assembly, an elongated shaft, an end effector, a rotationmechanism, and an articulation mechanism. The rotation mechanism isdisposed in mechanical cooperation with the handle assembly and effectsrotation of the end effector about the second longitudinal axis. Thearticulation mechanism is disposed in mechanical cooperation with thehandle assembly and effects movement of the end effector from a firstposition where the first longitudinal axis is substantially aligned withthe second longitudinal axis to a second position where the secondlongitudinal axis is displaced from the first longitudinal axis. Thearticulation mechanism comprises a first articulation control disposedin mechanical cooperation with the handle assembly, a first cable and asecond cable. Actuation of the first articulation control in a firstdirection causes the first cable to move distally and causes the secondcable to move proximally.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the presently disclosed surgical instrument aredescribed herein with reference to the drawings wherein:

FIG. 1 is a perspective view of an endoscopic forceps depicting a handleassembly, a flexible shaft, an articulation assembly, a rotationassembly, and an end effector assembly according to the presentdisclosure;

FIG. 2 is a cross-sectional view of the handle assembly, thearticulation assembly and a portion of the rotation assembly taken alongline 2-2 of FIG. 1;

FIG. 3 is a partial perspective, partial cross-sectional view of thefeatures shown in FIG. 2;

FIGS. 4 and 5 are perspective views of the articulation assembly ofFIGS. 1-3;

FIG. 6 is a perspective view of a portion of the articulation assemblyand a portion of the rotation assembly taken along line 6-6 of FIG. 1;

FIG. 7 is an assembly view of the forceps of FIG. 1;

FIGS. 8 and 9 are perspective views of a portion of the articulationassembly of the present disclosure;

FIG. 10 is an assembly view of the portion of the articulation assemblyof FIGS. 8 and 9;

FIGS. 11-14 are perspective views of another portion of the articulationassembly;

FIG. 15 is a perspective view of a slider of the articulation mechanismof the present disclosure;

FIG. 16 is a perspective view of the area of detail illustrated in FIG.1;

FIG. 17 is an assembly view of a portion of the articulation assembly ofthe present disclosure;

FIGS. 18-20 are cross-sectional views of portions of the articulationassembly and the rotation assembly of the present disclosure;

FIG. 21 is a perspective view of the forceps of the present disclosure;

FIGS. 22 and 23 are views of a portion of the articulation assembly ofthe present disclosure;

FIG. 24 illustrates an articulated distal end of the forceps of thepresent disclosure;

FIG. 25 is a perspective view of a handle portion of a second embodimentof the disclosed forceps;

FIG. 26 is a perspective view of the handle portion of FIG. 25 withportions of the handle assembly removed;

FIG. 27 is a perspective view of forceps according to a third embodimentof the present disclosure; and

FIG. 28 is a perspective view of the handle portion of FIG. 27 withportions of the handle assembly removed.

DETAILED DESCRIPTION

Referring initially to FIG. 1, one embodiment of an endoscopic vesselsealing forceps is depicted generally as 10. In the drawings and in thedescriptions which follow, the term “proximal,” as is traditional, willrefer to the end of the forceps 10 which is closer to the user, whilethe term “distal” will refer to the end which is farther from the user.The forceps 10 comprises a housing 20, an end effector assembly 100 andan elongated shaft 12 extending therebetween to define a longitudinalaxis A-A. A handle assembly 200, an articulation assembly 300 includingtwo articulation controls 310 and 320, and a rotation assembly 600 areoperable to control the end effector assembly 100 to grasp, seal anddivide tubular vessels and vascular tissue. Although the forceps 10 isconfigured for use in connection with bipolar surgical procedures,various aspects of the present disclosure may also be employed formonopolar surgical procedures. Additionally, while the figures depict acertain type of a forceps, other types of forceps and other endoscopicsurgical instruments are encompassed by the present disclosure. Furtherdetails of endoscopic forceps are described in commonly-owned U.S.Patent Publication No. 2010/0179540 to Marczyk et al., and U.S. patentapplication Ser. No. 12/718,143 to Marczyk et al., the entire contentsof each of which are hereby incorporated by reference herein

Further details of an endoscopic surgical stapling instrument includingsurgical fasteners are described in commonly-owned U.S. Pat. No.6,953,139 to Milliman et al., the entire contents of which are herebyincorporated by reference herein.

Generally, handle assembly 200 includes a fixed handle 210 and a movablehandle 220. The fixed handle 210 is integrally associated with thehousing 20, and the movable handle 220 is movable relative to fixedhandle 210 to induce relative movement between a pair of jaw members ofthe end effector assembly 100. The movable handle 220 is operativelycoupled to the end effector assembly 100 via a drive rod or a flexibledrive rod (not explicitly shown in the accompanying figures), whichextends through the elongated shaft 12, and reciprocates to inducemovement in the jaw members. The movable handle 220 may be approximatedwith fixed handle 210 to move the jaw members from an open positionwherein the jaw members are disposed in spaced relation relative to oneanother, to a clamping or approximated position wherein the jaw memberscooperate to grasp tissue therebetween. Electrosurgical energy may betransmitted through tissue grasped between jaw members to effect atissue seal. Further details of these components and various othercomponents of the disclosed forceps are disclosed in the references thathave incorporated in detail above.

Elongated shaft 12 of forceps 10 includes a distal end 16 dimensioned tomechanically engage the end effector assembly 100 and a proximal end 14,which mechanically engages the housing 20. The elongated shaft 12includes two portions: a proximal portion 12 a defining a proximal shaftaxis B-B and a distal portion 12 b defining a distal shaft axis C-C.

The proximal portion 12 a of the shaft 12 may exhibit variousconstructions. For example, the proximal portion 12 a may be formed froma substantially rigid tube, from flexible tubing (e.g., plastic), or theproximal portion 12 a may be formed as a composite of a flexible tubeand a rigidizing element, such as a tube of braided steel, to provideaxial (e.g., compressional) and rotational strength. In otherembodiments, the proximal portion 12 a may be constructed from aplastically deformable material.

The distal portion 12 b of shaft 12 includes an exterior casing orinsulating material disposed over a plurality of links 14 a, 14 b, etc.(see FIGS. 16 and 24; hereinafter “links 14”). The links 14 areconfigured to pivot relative to one another to permit the distal portion12 b of the shaft 12 to articulate relative to the proximal shaft axisB-B. In one embodiment, the links 14 are nestingly engaged with oneanother to permit pivotal motion of the distal portion 12 b in twoorthogonal planes in response to movement of articulation controls 310and 320. The links 14 may be shaped to permit the distal portion 12 b ofthe shaft 12 to be self-centering, or to have a tendency to return to anunarticulated configuration.

Articulation assembly 300 sits atop housing 20 and is operable viaarticulation controls 310 and 320 to move the end effector assembly 100(and the articulating distal portion 12 b of the shaft 12) in thedirection of arrows “U, D” and “R, L” relative to axis proximal shaftaxis B-B as explained in more detail below.

The links 14 each include a central lumen extending longitudinallytherethrough. The central lumen permits passage of various actuators,including a drive rod, a knife rod and four steering cables 901, 902,903 and 904 (e.g., FIG. 4) through the elongated shaft 12.

The four steering cables 901-904 may be substantially elastic andslideably extend through elongated shaft 12. A distal end of the each ofthe steering cables 901-904 is mechanically engaged with the endeffector 100. Proximal ends of the steering cables 901-904 areoperatively coupled to the articulation controls 310, 320 as describedbelow.

Referring now to FIGS. 2-6 the articulation assembly 300 permitsselective articulation of the end effector assembly 100 to facilitatethe manipulation and grasping of tissue. More particularly, the twocontrols 310 and 320 include selectively rotatable wheels, 311 and 321,respectively, that sit atop the housing 20. Each wheel, e.g., wheel 311,is independently moveable relative to the other wheel, e.g., 321, andallows a user to selectively articulate the end effector assembly 100 ina given plane of articulation relative to the longitudinal axis A-A. Forexample, rotation of wheel 311 articulates the end effector assembly 100along arrows R, L (or right-to-left articulation) by inducing adifferential tension and a corresponding motion in steering cables 902and 903. Similarly, rotation of wheel 321 articulates the end effectorassembly along arrows U, D (or up-and-down articulation) by inducing adifferential tension and a corresponding motion in steering cables 901and 904.

The articulation assembly 300 and the rotation assembly 600, comprisethe articulating-rotating mechanism and include wheels 311 and 321, anda rotation knob 610 to effect articulation and/or rotation of the endeffector 100. Details regarding the various components of thearticulating-rotating mechanism are described in detail below.

Distal ends of cables 901-904 are disposed in mechanical engagement withend effector 100, and travel proximally through shaft 12, as describedabove. Proximal ends of cables 901-904 are disposed in mechanicalcooperation with post assemblies 330 a-300 d, respectively. Each postassembly 330 includes a sleeve 332, which is disposed at least partiallyaround a post 334 (see FIGS. 9 and 10). It is envisioned that thesleeves 332 and the posts 334 are threadably engaged with each other toallow the tension of the cables to be adjusted.

With particular reference to FIGS. 9 and 10, an outer disc 350 and aninner disc 360 comprise a disc assembly 362. Each post 334 is connectedto outer disc 350 via pins 336, 338 and a ball joint 340. Theinteraction between the posts 334 and the outer disc 350 allow the posts334 to swivel about pins 336, 338 with respect to outer disc 350. Outerdisc 350 radially surrounds inner disc 360 and is rotatable around innerdisc 360. That is, a series of bearings 352 and clips 354 are disposedbetween inner disc 360 and outer disc 350 to enable outer disc 350 torotate with respect to inner disc 360. Additionally, as shown in FIG. 6,an outer portion of pins 338 engages a groove 612 in rotation knob 610.Thus, as rotation knob 610 rotates, outer disc 350, post assemblies 330,and cables 901-904 also rotate, which causes end effector 100 to rotatearound longitudinal axis A-A (or around the w-axis as discussed belowwith reference to FIG. 24).

The inner disc 360 is connected to housing 20 via a connector 370. Moreparticularly, inner disc 360 is connected to a distal portion ofconnector 370 via a ball joint connection 372, and connector 370 isstationary with respect to housing 20. Additionally, connector 370 ishollow, such that portions of elongated mechanisms (e.g., firing rod,knife rod, etc.) can be advanced between housing 20 and shaft 12. Suchelongated mechanisms are not illustrated in the accompanying figures inthe interest of visual clarity.

A pin 380 engages both ball joint connection 372 and inner disc 360. Anouter portion of pin 380 engages inner disc 360, and an inner portion ofpin 380 engages a slot 374 within ball-joint connection 372 (see FIG.6). This connection results in inner disc 360 being able to rotate withrespect to the X- and Z-axes, but unable to rotate with respect to thelongitudinal axis A-A. The orientation of inner disc 360 and outer disc350 results in outer disc 350 rotating with inner disc 360 around the X-and Z-axes. Additionally, as discussed above, outer disc 350 is alsoable to rotate around the longitudinal axis A-A when driven by rotationknob 610.

Referring now to FIG. 17, for example, articulation assembly 300 alsoincludes a block 400, a first disc 410, a second disc 420, a firstslider 430, and a second slider 440. First articulation control 310 isconnected to first disc 410 via a first post 470; second articulationcontrol 320 is connected to second disc 420 via a second post 480. Moreparticularly, an upper portion 472 of first post 470 is mechanicallycoupled to first articulation control 310 (e.g., via a pin), and a lowerportion 474 of first post 470 is mechanically coupled to first disc 410.An upper portion 482 of second post 480 is mechanically coupled tosecond articulation control 320 (e.g., via a pin), and a lower portion484 of second post 480 is mechanically coupled to second disc 420. Asshown in FIG. 17, lower portions 474, 484 of posts 470, 480 may includea polygonal-shape (e.g. a square) that is dimensioned to fit within acorresponding recess 411 in the corresponding disc 410, 420 (the lowerportion of first disc 410 is not shown). Additionally, an outer diameterof first post 470 is smaller than an inner diameter of second post 480,thus enabling first post 470 to extend through second post 480. Firstpost 470 also extends through an opening 401 in block 400 and an opening322 in first disc 320. As such, rotation of first articulation control310 causes rotation of first disc 410, and rotation of secondarticulation control 320 causes rotation of second disc 420.

Each disc 410, 420 has at least one arcuate slot 412, 422 therein. Inthe illustrated embodiments, discs 410, 420 each include two slots. Inthis embodiment, discs 410, 420 are identical to each other (and flippedabout the Z-axis (FIG. 6) with respect to each other), e.g., tofacilitate manufacturing. Following pins 414, 424 extend throughrespective slots 412, 422, and are coupled to respective sliders 430,440. The location of following pins 414, 424 can be adjusted withinrespective sliders 430, 440 by the mechanisms illustrated in FIGS. 15and 17. More particularly, sliders 430, 440 each include a slidableblock 432, 442 connected to respective pins 414, 424, and which areslidable within a cavity 434, 444. Proximal screws 435, 445 threadablyengage sliders 430, 440, and each abut a respective distal screw 436,446. Distal screws 436, 446 extend through and threadably engagerespective slidable blocks 432, 442, such that rotation of proximalscrews 435, 445 causes translation of respective slidable blocks 432,442, and thus pins 414, 424.

Additionally, sliders 430, 440 slidingly engage longitudinal slots 402,404, respectively, in block 400. As such, rotation of articulationcontrol 310 causes rotation of first disc 410, which causes followingpin 414 to move along arcuate slot 412, which causes slider 430 to movelongitudinally through longitudinal slot 402 in block 400. Likewise,rotation of articulation control 320 causes longitudinal translation ofslider 440 with respect to block 400.

Sliders 430, 440 are connected to inner disc 360 via a first connectingarms 500, 510 and second connecting arms 520, 530. First connecting arms500, 510 downwardly depend from respective sliders 430, 440 and areconnected to second connecting arms 520, 530, respectively, via balljoints 540, 550. Second connecting arms 520, 530 include proximalportions 522, 532 and distal portions 524, 534, which are longitudinallytranslatable (e.g., threaded) with respect to one another to allow thelength of second connecting arms 520, 530 to be adjusted. Secondconnecting arms 520, 530 are connected to inner disc 360 via ball joints560, 570. The ball joint 560, 570 connections allow three-dimensionalmovement (i.e., about the longitudinal axis A-A and the Y- and Z-axes)of disc assembly 362. Additionally, as shown in FIG. 5, for example,first connecting arm 520 is radially offset 90° from second connectingarm 530. That is, in the illustrated embodiment, first connecting arm520 engages inner disc 360 at a top portion thereof (i.e., in a 12:00position in FIG. 5), and second connecting arm 530 engages inner disc360 at a lateral portion thereof (i.e., in a 9:00 position in FIG. 5).

In use, rotation of first articulation control 310 causes first slider430 to longitudinally translate, which causes a top portion of discassembly 362 to move distally/proximally. Such movement by the topportion of disc assembly 362 causes upper cable 904 and lower cable 901to in opposite directions from one another (i.e., one cable movesdistally, the other cable moves proximally). When upper cable 904 ismoved distally (i.e., produces slack) and lower cable 901 is movedproximally (i.e., produces tension), end effector 100 articulatesdownwardly, in the substantial direction of arrow “D” in FIG. 1. Whenupper cable 904 is moved proximally and lower cable 901 is moveddistally, end effector 100 articulates upwardly, in the substantialdirection of arrow “U” in FIG. 1. As can be appreciated, rotation ofsecond articulation control 302 causes translation of cables 902, 903(see FIG. 23), which causes end effector 100 to articulate in thedirections of arrows “R” and “L” in FIG. 1.

Further, with particular reference to FIG. 24, when the end effector 100is articulated in a particular direction and amount (e.g., “R” in FIG.24), and when coordinate system {u, v, w} is associated with the endeffector 100. FIG. 24 illustrates that rotation of rotation knob 610about longitudinal axis A-A, causes the end effector 100 to rotate aboutaxis “w”; end effector 100 does not rotate around longitudinal axis A-A.Thus, the end effector 100 maintains its articulation (i.e., its “R”position in FIG. 24) while being able to rotate about the w-axis.

Additionally, in the illustrated embodiments, first disc 410 and seconddisc 420 include serrations along perimeters thereof. A member 490, asshown in FIG. 17, includes a distal end 492 that is biased into eachdisc 410, 420 via a spring 494, such that rotation of articulationcontrol 310 and/or 320 causes distal end 492 of member 490 to contactsuccessive serrations, which produces an audible sound to facilitateuse.

Another forceps 10′ according to an embodiment of the present disclosureis illustrated in FIGS. 25 and 26. This embodiment includes a singlearticulation control 310, a single disc 410, and a single slider 430. Inthis embodiment, a user can rotate articulation control 310 in additionto the housing 20 for full articulation control of end effector 100.

FIGS. 27 and 28 illustrate another embodiment of a forceps 10″ havinghousing 20′, which is usable with the articulation assembly 300 androtation assembly 600 of the present disclosure. As illustrated, housing20′ lacks a movable handle. Here, it is envisioned that any type ofactuation mechanism, including powered actuation, is usable with forceps10″.

While several embodiments of the disclosure have been depicted in thedrawings, it is not intended that the disclosure be limited thereto, asit is intended that the disclosure be as broad in scope as the art willallow and that the specification be read likewise. Therefore, the abovedescription should not be construed as limiting, but merely asexemplifications of particular embodiments. Those skilled in the artwill envision other modifications within the scope and spirit of theclaims appended hereto.

What is claimed is:
 1. A surgical instrument, comprising; a handleassembly; an elongated shaft extending distally from the handle assemblyand defining a first longitudinal axis; an end effector disposed inmechanical cooperation with a distal portion of the elongated shaft, theend effector defining a second longitudinal axis and including a pair ofjaw members; a rotation mechanism disposed in mechanical cooperationwith the handle assembly, the rotation mechanism configured to rotatethe pair of jaw members of the end effector about the secondlongitudinal axis by a rotation of at least a portion of the rotationmechanism about the first longitudinal axis relative to the handleassembly; an articulation mechanism disposed in mechanical cooperationwith the handle assembly for effecting movement of the end effector froma first position where the first longitudinal axis is aligned with thesecond longitudinal axis to a second position where the secondlongitudinal axis is disposed at a non-parallel angle with respect thefirst longitudinal axis, wherein the second position of the end effectorremains unchanged in response to actuation of the rotation mechanism; afirst disc disposed in mechanical cooperation with the articulationmechanism and being rotationally fixed about the first longitudinal axisrelative to the handle assembly; and a second disc disposed inmechanical cooperation with the rotation mechanism and being rotatableabout the first longitudinal axis and relative to the handle assembly,at least a portion of the first disc being disposed at the samelongitudinal position along the first longitudinal axis as at least aportion of the second disc.
 2. The surgical instrument according toclaim 1, wherein at least a majority of the first disc is closer to thefirst longitudinal axis than at least a majority of the second disc. 3.The surgical instrument according to claim 1, wherein an outer perimeterof the first disc is in contact with an inner perimeter of the seconddisc.
 4. The surgical instrument according to claim 1, wherein the firstdisc is in contact with the second disc while the end effector is in thefirst position and in the second position.
 5. The surgical instrumentaccording to claim 4, wherein the first disc is in contact with thesecond disc throughout rotation of the at least a portion of therotation mechanism about the first longitudinal axis relative to thehandle assembly.
 6. The surgical instrument according to claim 1,wherein the at least a portion of the first disc is disposed at the samelongitudinal position along the first longitudinal axis as the at leasta portion of the second disc while the end effector is in the firstposition and the second position.
 7. The surgical instrument accordingto claim 6, wherein the at least a portion of the first disc is disposedat the same longitudinal position along the first longitudinal axis asthe at least a portion of the second disc throughout rotation of the atleast a portion of the rotation mechanism about the first longitudinalaxis relative to the handle assembly.